A Survey of Physician Opinion

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Abstract
Background Based on recent evidence of inconsistent outcomes after the closed treatment of adult midshaft clavicle fractures, the management of similar fracture patterns in adolescents is being reevaluated. The primary aim of this study is to report current treatment preferences for adolescent midshaft clavicle fractures among pediatric orthopaedic physicians and to determine if recent adult literature has influenced clinical decision making. Methods An invitation email to a cross-sectional, web-based survey was sent to all members of the Pediatric Society of North America. With reference to adolescent sex and age, respondents were prompted to indicate their treatment preference (operative vs. nonoperative) in 4 common midshaft clavicle fracture patterns. The respondents were also asked to indicate if the following factors: findings in current literature supporting operative fixation in adults, arm dominance, and/or athletic status, influenced their preference for operative versus nonoperative management. Results Of the 949 Pediatric Society of North America members, 302 responded in full (32% response rate). The majority of physicians preferred nonoperative treatment for all fracture patterns. A logistic regression analysis revealed: older adolescent age (12 to 15 y vs. 16 to 19 y.) and evidence in recent adult literature (influence vs. no influence) to be significantly (P<0.01) predictive of physician preference toward operative fixation in angulated, displaced, and isolated segmental clavicle fracture patterns. Physician years of experience (5 y) significantly predicted treatment preferences in isolated segmental fractures only. Conclusions The percentage of physicians in favor of operative fixation tended to increase in reference to older adolescents and more severe fracture patterns but, nonoperative management was preferred in all fracture patterns. Evidence in recent adult literature was found to be the most significant factor influencing treatment preferences in this survey. Randomized controlled trials are needed to evaluate the efficacy of primary operative fixation of midshaft clavicle fractures in adolescent populations. Level of Evidence Cross-sectional electronic survey; level V-expert opinion.

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